Prostate Cancer

Active surveillance of prostate cancer with delayed intervention

“Active surveillance” is an approach for certain older men who have a limited amount of prostate cancer. Instead of receiving immediate treatment, patients are followed closely to see if and when the cancer grows or gets worse. Treatment is not given until the cancer progresses.

Patients are “followed” with PSA (prostate specific antigen) tests every few months, and an ultrasound and biopsy are repeated 6-12 months after diagnosis and perhaps yearly after that.

This approach is an option for some men, with certain tumor features. Experience and autopsy studies show that prostate cancer is present in many men, but it may be slow-growing and not be the cause of their death. By delaying or avoiding treatment for prostate cancer, side effects of treatment may be also be delayed or avoided. Of course, treatment can be offered at any time if a man and his doctor decide to proceed with it.

An option for certain patients

There are certain factors that the urologist looks at to see if a man should be offered active surveillance. These may include: age 65 or older, a limited amount of cancer in the prostate, a PSA score less than 10, a Gleason score of 6 or less, and other specified tumor characteristics.

Talk to your doctor

The concept of active surveillance is not universally accepted. The assessment of prostate cancers is not a perfect science, and the decision to offer active surveillance varies from doctor to doctor. Also, certain treatments for very small tumors may cause few side effects. In addition, some men are not comfortable with “waiting”; they want the cancer treated or removed without delay.
But for men with a small amount of non-aggressive prostate cancer, active surveillance should be considered.

Active surveillance doesn't mean "no treatment"

“Active surveillance” is not the same as “watchful waiting”, a term that refers to delaying any treatment until the development of symptoms from advanced prostate cancer. “Watchful waiting” is an older phrase, used before the development of ways to monitor prostate cancer before it spreads (metastasizes) to other areas.